Introduction
In late 2009, Marc Dupont, CEO of Saintemarie University Hospital, had just ended an
extremely tense phone conversation with the state secretary of health. The secretary was very
concerned about the wait time in the hospital’s emergency department (ED). The recent
coverage of these problems in the local press, which repeatedly echoed complaints of
patients and their families, was making things worse:
It took them 18 hours to take care of my mother when she was admitted to
the emergency department in the Saintemarie University Hospital —
Saintemarie Tribune (March 2009)
On September 8, Nancy (86 years old) had to wait eight hours in the ED with
a broken leg before seeing a doctor — Saintemarie Tribune (September 2009)
Saintemarie was a midsize European city with a population of 512,000. A few private clinics
in the area provided urgent care (i.e., treatment which does not require hospitalization), but
were unable to handle acute emergencies. The hospital’s ED was the only emergency care
unit available in the Saintemarie metropolitan area. The only alternative to it was a hospital
located 50 miles away; patients had to be transferred there by helicopter, which happened
rarely because such transfers were extremely expensive. Given its central role, Saintemarie
University Hospital was under the constant scrutiny of local and state officials.
ED congestion can have significant repercussions on a hospital’s ability to provide quality
care for patients, many of whom require immediate attention. The secretary of health
recognized that the long delays at the city’s primary ED were a substantial public health